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14259 Michigan Street

PO Box 129

Eagle, MI 48822

517-940-4210 www.michiganscouting.org

INDIVIDUAL RELEASE AND INDEMNITY


I understand that the use of facilities at D-Bar-A (the “MCC Property”), a camp or office property owned or operated by Michigan Crossroads Council., Inc. Boy Scouts of America or one of its subsidiary councils (collectively, the “MCC”), and the conduct of activities at the MCC Property are strenuous and involve risk (including, without limitation, the risks of serious injury, permanent injury, and death).

After careful analysis of the risks involved, and in consideration of the benefits to be derived by the undersigned from the use of, and activities at, the MCC Property, as well as for other good and valuable consideration (the receipt and sufficiency of all of which are hereby acknowledged), the undersigned hereby:

1. Waiver of Liability:EXPRESSLY WAIVES AND RELEASES all claims, causes of action, costs, damages, expenses, losses, liabilities and suits (including, without limitation, any claim, cause of action, demand or assertion of liability under any municipal, state, federal or other law (including any action under the Americans with Disabilities Act)) against (i) Boy Scouts of America, Inc., (ii) MCC, and (iii) all affiliates, agents, associates, chartered organizations, directors, employees, officers, leaders, members, representatives, servants and volunteers of each of the foregoing (all of the persons and entities described in clauses (i)-(iii) being, jointly and severally, the “Indemnified Persons”), on account of any personal injury, property loss, damage, accident, death, injury, illness, or loss suffered by the undersigned that arises from, or as a result of, or incidental to, or in connection with, the undersigned’s use of, or presence on, the MCC Property or any services, structures or equipment located in, on or about the MCC Property (a “Loss”) and further agrees and covenants not to sue or make such claims on behalf of myself, my minor children, and assigns, heirs or survivors.

2.  Indemnification: AGREES TO indemnify and hold harmless the Indemnified Persons, and each of them, and will assume liability for and reimburse the Indemnified Persons, and each of them, for (i) any such Loss, (ii) any claim, cause of action, demand or assertion of liability under any municipal, state, federal, or other law (including any action under the Americans with Disabilities Act) (a “Claim”); and (iii) any loss, liability, claim, damage and expense (including, discovery costs, investigation costs and reasonable attorneys’ fees and expenses) suffered or incurred by the Indemnified Persons arising from, or as a result of, or incidental to, or in connection with, any such Loss or Claim.

3. Fitness: AFFIRMS that I have the mental and physical fitness for any activity in which I am participating and will comply with all applicable rules.


If signatory is less than 18 years of age, this must also be signed by a parent or legal guardian.


Today's Date: May 10, 2026

First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
Information

MCC Property to be used: D-Bar-A

Starting Date MCC Property will be used: 6-18-2026

Ending Date MCC Property will be used: 6-20-2026

Organization: The Church of Jesus Christ of Latter-day Saints 

First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

MCC Property to be used: D-Bar-A

Starting Date MCC Property will be used: 6-18-2026

Ending Date MCC Property will be used: 6-20-2026

Organization: The Church of Jesus Christ of Latter-day Saints 

Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

MCC Property to be used: D-Bar-A

Starting Date MCC Property will be used: 6-18-2026

Ending Date MCC Property will be used: 6-20-2026

Organization: The Church of Jesus Christ of Latter-day Saints 

Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

MCC Property to be used: D-Bar-A

Starting Date MCC Property will be used: 6-18-2026

Ending Date MCC Property will be used: 6-20-2026

Organization: The Church of Jesus Christ of Latter-day Saints 

Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

MCC Property to be used: D-Bar-A

Starting Date MCC Property will be used: 6-18-2026

Ending Date MCC Property will be used: 6-20-2026

Organization: The Church of Jesus Christ of Latter-day Saints 

Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

MCC Property to be used: D-Bar-A

Starting Date MCC Property will be used: 6-18-2026

Ending Date MCC Property will be used: 6-20-2026

Organization: The Church of Jesus Christ of Latter-day Saints 

Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

MCC Property to be used: D-Bar-A

Starting Date MCC Property will be used: 6-18-2026

Ending Date MCC Property will be used: 6-20-2026

Organization: The Church of Jesus Christ of Latter-day Saints 

Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

MCC Property to be used: D-Bar-A

Starting Date MCC Property will be used: 6-18-2026

Ending Date MCC Property will be used: 6-20-2026

Organization: The Church of Jesus Christ of Latter-day Saints 

Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

MCC Property to be used: D-Bar-A

Starting Date MCC Property will be used: 6-18-2026

Ending Date MCC Property will be used: 6-20-2026

Organization: The Church of Jesus Christ of Latter-day Saints 

Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

MCC Property to be used: D-Bar-A

Starting Date MCC Property will be used: 6-18-2026

Ending Date MCC Property will be used: 6-20-2026

Organization: The Church of Jesus Christ of Latter-day Saints 

Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Information

MCC Property to be used: D-Bar-A

Starting Date MCC Property will be used: 6-18-2026

Ending Date MCC Property will be used: 6-20-2026

Organization: The Church of Jesus Christ of Latter-day Saints 

Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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